Accurate esophageal cancer staging is important, as appropriate treatment and patient outcome are stage-dependent. Detection of distant metastases is performed with radiology imaging studies. For locoregional T staging, EUS is superior to CT with overall approximate 80-90% accuracy. Patients with T2-T4 cancers cannot be treated endoscopically and typically need a combination of chemoradiation and surgery. T1 cancers are grouped into T1m involving the mucosa and/or deep mucosa or muscularis mucosa and T1sm involving the submucosa, as seen on this patient’s EUS image. T1sm tumors have a 10-30% probability of regional lymph node metastases and should be resected surgically. Only T1m or intramucosal cancers may be treated with endoscopic mucosal resection. Endoscopic radiofrequency ablation may be used to treat Barrett’s esophagus with low-grade dysplasia and/or high-grade dysplasia, but is not indicated for treatment of cancers.
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